DEI Faculty Spotlight: Gerard Silvestri, M.D., MS

Natalie Wilson
May 23, 2022
Silvestri Faculty Spotlight

As part of the Department of Medicine’s goal to promote a culture that values and honors diversity, equity, and inclusion, we’re “spotlighting” DOM faculty, trainees and staff who are engaged in academic and community work that supports diversity, equity and inclusion.

Read the below interviews with Gerard Silvestri, M.D., Hillenbrand Professor of Thoracic Oncology and lung cancer pulmonologist in the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, about his work to address lung cancer disparities.

Lung Cancer Disparities

Dr. Silvestri 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.

A 28 year-veteran of the department, Dr. Silvestri began the first multidisciplinary lung cancer clinic in South Carolina, and now evaluates between five and seven new lung cancers per week. His clinical research is patient-oriented and directed towards nearly every aspect of lung cancer care. He has unparalleled experience in lung cancer screening, health services research, and evaluating new technologies for the diagnosis and staging of lung cancer. He is an author and editor of the American College of Chest Physicians (ACCP) lung cancer guidelines and has published more than 270 scientific articles, book chapters and editorials. Dr. Silvestri currently serves on the editorial board of Chest and was the 2017 President of the American College of Chest Physicians. Additionally, he currently serves as the Senior Vice Chair for Faculty Development in the Department of Medicine.

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, 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.
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 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.

Lung cancer is unique because it occurs primarily in smokers. According to the Centers for Disease Control and Prevention (CDC), approximately 30% of uninsured adults smoke, and smoking is more prevalent among people with a low annual household income. Since many smokers fall into a segment of the population that lacks insurance, this can affect their ability to pursue care, as many uninsured individuals will not seek regular lung cancer screening, Silvestri said.

“Fortunately, the cancer center is really well-positioned to help smokers with programmatic support,” said Silvestri. Hollings, 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.

Silvestri hopes this research will be a catalyst for conversations about the financial toxicity of cancer treatment, at the state and national level.
“People who want to change the paradigm need to make it personal and share the numerous stories of patients who, after they are told they have cancer and their world is turned upside down, are forced to ask, ‘How am I going to afford this?’ rather than ‘What can we do to cure me?’” said Silvestri.

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Hollings Cancer Center and newly formed Southeastern Consortium for Lung Cancer Health Equity awarded $3 Million Stand Up To Cancer grant

Earlier this year, MUSC Hollings Cancer Center received its first Stand Up To Cancer (SU2C) grant that will make it part of the Southeastern Consortium for Lung Cancer Health Equity (SC3), a group that will focus on why lung cancer continues to be one of the leading causes of death among racially and ethnically diverse populations in the nation.

The $3 million four-year grant will facilitate health disparities research and scientific collaborations among researchers at three NCI-designated cancer centers and form the SU2C Lung Cancer Health Equity Research Team. The grant is made possible by the support of Bristol Myers Squibb and is a part of SU2C’s Health Equity Initiative.

The initiative focuses on increasing diversity in cancer clinical trials, initiating advocacy group collaborations and awareness campaigns and funding research aimed at improving cancer outcomes and screening rates in medically underserved communities. In addition to Hollings, the team will include Massey Cancer Center at Virginia Commonwealth University and Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill. This study is being led by Marvella Ford, Ph.D., associate director of Population Sciences and Cancer Disparities Research at Hollings.

The translational science component of the grant at Hollings will be led by Dr. Silvestri. All three states — North Carolina, South Carolina and Virginia — are in the Tobacco Belt, with high rates of lung cancer and disparities, he said.

One goal of the grant is to develop a population-based collection of samples to look for new lung cancer biomarkers, including in underserved communities to ensure equal representation.

“No one has looked at genetic profiling specifically in the underserved communities. What if we can find a cost-effective biomarker to show increased or decreased lung cancer risk to make better use of cancer screening resources?” asked Silvestri, adding that this new consortium is an invaluable outcome of the SU2C grant.

“We will be sharing samples, resources and clinical data in order to make a meaningful difference in the underserved communities. As a consortium, we will be able to apply for larger grants in the future that we could not get if we were working on our own.”

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