Kentucky has historically led the nation in lung cancer rates, but the statistics are turning around thanks to a decade-long statewide effort to engage more people in screening.
Kentucky's lung cancer screening rates have improved significantly and remain above the national average. The state's rate of late-stage lung cancer diagnoses has declined at double the national rate over the past decade. These improvements in lung cancer detection and mortality are driving declines in Kentucky's overall cancer mortality rates.
Two programs housed at the University of Kentucky Markey Cancer Center - the Kentucky LEADS Collaborative and the Kentucky Cancer Consortium Lung Cancer Network - have been central to the statewide effort.
Why screening matters
Lung cancer screening involves a simple CT scan that can identify tumors before symptoms appear, when treatment is most effective. The screening is recommended for adults aged 50 to 80 with significant smoking histories.
With non-small cell lung cancer's overall five-year survival rate at just 28%, early detection and immediate intervention are critical. When caught at early stages, survival rates can reach 90% or higher.
"This isn't your grandfather's lung cancer. Today, more Kentuckians are surviving after a lung cancer diagnosis than ever before," said Timothy Mullett, M.D., a thoracic surgeon at Markey Cancer Center who has been a co-lead the in the KY LEADS Collaborative. "Advancements in early detection and treatment mean that if found early, lung cancer can often be treated successfully - and in many cases, even cured."
Building better screening programs
After the U.S. Preventive Services Task Force first released lung cancer screening guidelines in 2013, the Kentucky Cancer Consortium Lung Cancer Network and the Kentucky LEADS (Lung Cancer Education Awareness Detection Survivorship) Collaborative were created with the shared goal of making the state a leader in lung cancer screening.
A key part of the strategy has been helping health care systems across Kentucky build better lung cancer screening programs.
Mullett, along with Markey researcher and UK College of Public Health faculty member Jennifer Redmond Knight, Dr.P.H., and Jamie Studts, Ph.D., now at the University of Colorado Cancer Center, Allyson Yates, and Joseph "Trey" Alexander co-developed the QUILS™ (Quality Implementation of Lung Cancer Screening) System through the KY LEADS Collaborative. The quality improvement program helps lung cancer screening programs evaluate and improve their services by examining factors like patient eligibility, tobacco cessation support and helping providers explain screening risks and benefits. The LCSPs then receive tailored feedback on what's working and what needs improvement.
Since it was launched in 2014, the QUILS system began with 10 lung cancer screening programs and has now been conducted nearly 30 times throughout Kentucky.
Health professionals across Kentucky also learn from each other through the Kentucky Lung Cancer Screening Learning Collaborative, a statewide forum where health care professionals share strategies and tackle common challenges.
The collaborative, hosted by the Kentucky Cancer Consortium, QUILS group, and the Kentucky Department for Public Health, brings together professionals from more than 100 organizations across the state.
"The Kentucky Lung Cancer Screening Learning Collaborative is creating a powerful space for connection and progress," said Elaine Russell, Kentucky Cancer Consortium program director. "Participants value the chance to share strategies and learn from different perspectives across the state. By bringing partners together and providing a clear picture of statewide and national efforts, the collaborative strengthens networks, sparks ideas and reminds us that while challenges remain, this collaborative is helping Kentucky move forward - together."
Markey researchers developed the collaborative model and facilitate discussions throughout the year. Participants - including radiologists, primary care physicians, patient navigators, social workers and public health professionals - meet regularly to discuss practical topics like patient outreach, insurance coding and integrating tobacco treatment into screening visits.
A model for other states
The success of the collaborative approach has drawn national attention. The Kentucky Cancer Consortium's Lung Cancer Network is funded by the Centers for Disease Control and Prevention and the Kentucky LEADS Collaborative was originally funded through support from the Bristol Myers Squibb Foundation.
The QUILS group recently received a new $6.8 million grant from the Bristol Myers Squibb Foundation for a project aimed at replicating the QUILS System in Mississippi and Nevada. The National Cancer Institute is also funding an additional study to test the QUILS system at 60 sites across nine states, with Mullett and Knight serving as co-principal investigators.
While Kentucky's model is spreading across the U.S., the work continues at home. Despite Kentucky's progress, only about one in five eligible residents are screened for lung cancer, and Markey researchers are focused on reaching the remaining 80% of eligible Kentuckians.
The QUILS system continues to be expanded in Kentucky through funding support from the Kentucky Lung Cancer Screening Program and has also received funding from Anthem Kentucky Managed Care Plan.
"We have worked together for more than 11 years to change the lung cancer story throughout Kentucky," said Knight, an associate professor in the UK College of Public Health. "Kentucky is where we started, and it's still where we're most determined to make a difference."
