Reaching Those at Greatest Risk

Dec 14, 2018 at 11:55 am by steve

Claudia Hardy, MPA

Grant Enables UAB to Launch Lung Cancer Outreach, Screening Program

Lung cancer is the number one cause of cancer deaths in America and the nation's second most common cancer in both men and women, not counting skin cancer. While prostate cancer is more common in men and breast cancer in women, lung cancer is responsible for far more deaths than both of those combined.

In fact, the American Cancer Society estimates nearly 14 percent of all new cancers are lung cancers. Despite knowing significant risk factors for the disease including smoking and exposure to secondhand smoke, lung cancer often isn't caught until symptoms have progressed to a point where the disease is already at an advanced, non-curable stage.

While it has been challenging to catch the disease early, the National Lung Screening Trial showed using low-dose CT (LDCT) scans to screen people at higher risk for lung cancer did detect abnormalities before symptoms started. The study included more than 50,000 current and former smokers ages 55 to 74 who were in fairly good health. Those enrolled in the study had to have a 30 pack-year history, and former smokers had to have quit within the past 15 years. Study participants were randomized to either three LDCT scans or three chest x-rays given a year apart. The study found those who received LDCT had a 20 percent lower chance of dying from lung cancer than those who received chest x-rays.

Now the University of Alabama at Birmingham has the opportunity to reach out to high-risk populations in seven counties to use LDCT screening for early identification and intervention. Claudia Hardy, MPA, program director for the Office of Community Outreach for UAB Comprehensive Cancer Center, said her office is working in partnership with Lung Cancer Alliance on a $1.6 million grant from the Bristol-Myers Squibb Foundation to reach underserved Alabamians who are most at risk for lung cancer.

The three-year grant establishes the Alabama Lung Cancer Awareness, Screening and Education program (ALCASE). "It's going to allow us to expand our existing infrastructure to lung cancer, as well as breast, cervix and colorectal cancers," Hardy explained of building on their already successful screening and education programming. "The ultimate goal is to screen 250 men and women between the ages of 55 and 75 for lung cancer."

Hardy said ALCASE will combine Lung Cancer Alliance's expertise in screening with UAB's Deep South Network Community Health Advisor model to decrease disparities. The Community Health Advisors (CHAs) are lay individuals within a community who have been identified as leaders and trained in cancer education and outreach. "They are trusted individuals in their community. They're an extension of our office, and they enable us to go into communities that we otherwise would not be able to get into," Hardy said.

In fact, it was the previous use of CHAs that helped secure UAB's participation in the current grant. "We were able to successfully reduce or reverse the disparities that existed for mammography screening rates between African American and Caucasian women who were Medicare recipients through our Community Health Advisor model," she said. "That's the beauty of the program," Hardy continued. "They are an extension of the office, but they are right there in the community 24/7 to link individuals to services and care."

ALCASE will be deployed in seven counties. Jefferson County captures the urban Birmingham metropolitan area with the six other counties being in the Alabama Black Belt, an area of the state known for its rich black soil and deep agricultural roots. Choctaw, Dallas, Greene, Hale, Marengo and Sumter counties will all be part of the rural cluster that features a large African American population, limited financial resources, and access to care issues.

Hardy noted access and treatment will have to be addressed through a number of mechanisms including transportation assistance. The grant requires the LDCT screening be conducted in designated centers of excellence. "There are less than five radiology centers of excellence in these areas," Hardy noted. "Some of the counties don't have a hospital at all."

With lung cancer disproportionately impacting people of color, there is certainly a need for improved education and awareness in the region. Unlike the well-established guidelines for mammography, cervical cancer screening and colonoscopies, Hardy pointed out screening for lung cancer isn't promoted in the same way as these other cancers.

Further complicating the diagnosis and treatment process, she continued, "For this particular cancer, many of the symptoms may mimic lesser issues like a sinus infection, common cold or pneumonia." By the time the symptoms have progressed to a point where an individual seeks medical care, the cancer has often advanced past the early stages.

Currently, Hardy's office is actively working to create the curriculum for lung cancer awareness, education, risk stratification and screening. The team is also getting staff in place before reaching out to potential CHAs, who will spend about two months training for their role. "We won't begin screenings and referrals for screening until late spring," she said of the timeline.

Hardy added, "Local healthcare providers can definitely contact us if they have high-risk individuals who need assistance with getting a screening done or if they know of someone who would be a great Community Health Advisor." Reach out to Hardy through her email - - or by phone at (205) 975-5454.


UAB Comprehensive Cancer Center

Office of Community Outreach

Sections: Clinical

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