Mitigating lung cancer disparities: spotlight on Dr. Gerard Silvestri

 

Gerard Silvestri, M.D., Hillenbrand Professor of Thoracic Oncology and lung cancer pulmonologist in the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, is an international expert in lung cancer and interventional pulmonology who has dedicated his career to the evaluation, management, and improvement of outcomes for lung cancer patients.

Some of his most recent work to address lung cancer disparities is featured below:

New study finds barriers still exist with lung cancer screening access

A study led by Dr. Silvestri found that the recent changes to lung cancer screening guidelines may paradoxically increase health disparities rather than reduce them, given a gap of insurance coverage for some people. The study was published in JAMA Network Open in Oct. 2021.

In 2021, lung cancer screening guidelines from the United States Preventive Services Task Force (USPSTF) were revised, lowering the age and pack-year requirements for screening from 55 years to 50 years and 30 pack-years to 20 pack-years, respectively. A pack-year is smoking an average of one pack of cigarettes per day for one year.

These changes were made to expand eligibility to around 7 million more Americans in the hopes of diagnosing lung cancer at an earlier more curable stage and reducing mortality. These proposed changes seemingly would have been of great benefit to Blacks, as they develop lung cancer at a younger age and with less of a smoking history. However, Dr. Silvestri’s team found that while the intent of expanding screening eligibility was good, it did not resolve the barrier of access.

Researchers found only 20% of eligible Blacks under 65 were being screened versus 80% of Blacks over 65 being screened, whereas the number of whites screened was equal below and above age 65. At age 65, everyone becomes eligible for Medicare and has access to insurance.

This is of particular concern in South Carolina where nearly 30% of the state’s population is Black. Even for those patients with health insurance, lack of access to screening is still a widespread problem. It’s why MUSC Health recently expanded its lung cancer screening program to regional hospitals that are closer to rural and medically underserved communities.

Dr. Silvestri said the study shows that more needs to be done to improve lung cancer screening rates than just expanding eligibility requirements.

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Hollings researcher identifies that insurance status affects cancer outcomes more than age

In a paper published in the May 2021 issue of Health Affairs, Dr. Silvestri found that a lack of insurance leads to worse cancer survival than for those with Medicare. This work, a joint effort between Dr. Silvestri and researchers at the American Cancer Society, highlights the current dire barrier in medical care: Many people cannot take advantage of the newer potentially lifesaving treatments due to the high costs.

“Fortunately, the cancer center is really well-positioned to help smokers with programmatic support,” said Dr. Silvestri. Hollings Cancer Center, which is the state’s only National Cancer Institute-designated cancer center, has a robust smoking cessation program, a lung cancer screening program, as well as rigorous disparities research, which has led to the implementation of novel programs across the state, he said.

Dr. Silvestri hopes this research will be a catalyst for conversations about the financial toxicity of cancer treatment, at the state and national level.

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New Effort to expand cancer screenings in underserved S.C. communities

Dr. Silvestri and Hollings cancer disparities researcher Marvella Ford, Ph.D., are combining their medical and behavioral science expertise to get more people to cancer screenings,

Earlier this year, they led Hollings to receive a Stand Up to Cancer grant and become part of the Southeastern Consortium for Lung Cancer Health Equity, which has as one of its goals improving cancer outcomes and screening rates in medically underserved communities.

Now, they are co-leaders of a $1.2 million grant to Hollings from The Duke Endowment, with ambitious goals to increase screening rates for five cancers and expand biomarker research trials by working with the regional hospitals in Florence, Lancaster, Chester, Marion, Columbia, and Kershaw and a new facility scheduled to open in 2023 to serve Lake City and Williamsburg County. To date, the Charleston screening program has expanded into MUSC Health-Lancaster Division, MUSC Health-Florence Division and MUSC Health-Midlands Division.

The Duke Endowment Grant establishes the Center for Cancer Equity and Engagement at Hollings, a center that will house this and many other health disparity initiatives.

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