Houston VA lung cancer screening program saves lives

Less than two years in, an innovative lung cancer screening program at the Michael E. DeBakey VA Medical Center in Houston is already saving Veterans’ lives. Since its launch in May 2021, the Lung Precision Oncology Program (LPOP) at the hospital has made 30 lung cancer diagnoses, more than 90% of which were found in the early stage, when it is most curable.

None of the 30 Veterans with early-stage lung cancer had any symptoms, explained Dr. Farrah Kheradmand, who is the contact director of the Houston LPOP along with her co-principal investigator Dr. Lorraine Cornwell. Thanks to the lung cancer screening program that was rapidly expanded through LPOP support, these Veterans have a much greater chance of beating the disease.

LPOP is a national VA initiative that gives VA clinicians a range of tools to proactively detect and provide innovative lung cancer care for Veterans. Its overarching mission is to improve the lives of Veterans with cancer through early detection and precision medicine. Under LPOP’s banner, the Michael E. DeBakey VA Medical Center coordinates screening, genetic testing, and clinical trials to bring cutting-edge cancer care to Veterans.

Ever since launching LPOP in May 2021, the Houston VA hospital has been steadily ramping up its program to bring important cancer screenings to even more Veterans. In the program’s first month, 11 Veterans received a computed tomography (CT) scan. As of May 1, about 175 Veterans are scanned each month. Overall, the Houston team has screened 3,900 and enrolled more than 2,340 Veterans in their lung cancer screening program.

“The LPOP initiative put the wind behind the sails to push our cancer screening program forward,” said Kheradmand.

The team has also expanded services from the hub site at the Michael E. DeBakey VA Medical Center to three spoke sites VA facilities in the community, with a fourth spoke in the process of getting up and running.

Of the 28 counties the Houston VA Health Care System serves, 14 are mostly rural, with Veterans needing to travel for more than two hours to get to the Michael E. DeBakey VA Medical Center in some cases. Kheradmand explained Veterans from these rural counties will benefit from the same quality of cancer screening and care as Veterans who get their care in Houston, and the spoke sites will dramatically increase the reach of the program.

“The LPOP spoke sites serve a large number of Veterans who also live in rural areas,” she added. “If they emulate what we did in Houston, they could have a huge impact.”

In addition to the spoke sites, Dr. Steven Bujarski, who leads the lung cancer screening program in Houston, is pursuing a mobile CT unit that could travel to smaller VA facilities that don’t have CT machines of their own and provide screens for lung cancer on site, rather than requiring Veterans to travel to Houston.  This kind of innovation is just a small part of the LPOP program’s large research component.

One of LPOP’s main missions is to sponsor new clinical trials to improve precision oncology, which uses genetic testing and molecular tumor analysis to tailor treatment to each individual patient. The Houston VA is also involved in trials to discover new biomarkers for cancer risk.

Kheradmand explained that while many Veterans are reluctant to get screened for lung cancer, if doctors show them they have a biomarker that suggests a higher risk of cancer it often helps convince them to get screened. The Houston VA rapidly became one of the largest recruiting sites for a lung cancer biomarker study run by the cancer biopsy company Nucleix.

VA researchers in Houston are also conducting clinical trials for new drugs and immunotherapy to treat non-small-cell lung cancer. Other research projects will investigate areas such as quality control of cancer screening, ways to predict how well patients will respond to cancer treatments, and a potential new way to treat advanced lung cancer.

While the LPOP research program first started as an eight-site pilot project in 2014, it currently operates at 99 sites across the country, including 23 hub sites like the Michael E. DeBakey VA Medical Center, which coordinate with all the other locations in their region. Those original pilot sites, like the San Francisco VA, demonstrate what the Houston LPOP can achieve as it continues to grow. The San Francisco LPOP screens more than 900 Veterans for lung cancer each year and has detected more than 100 lung cancer cases, nearly 80% of which were in the early stages. Nationwide, nearly 112,000 Veterans have been screened for lung cancer across all LPOP sites to date. 

Impressive as those numbers are, it’s only a fraction of the total problem. An estimated 900,000 Veterans are at risk for lung cancer due to age, smoking, and environmental exposures during and after military service, which may be why Veterans have a higher rate of lung cancer and a lower rate of survival than the general population. Nearly 8,000 Veterans are diagnosed and treated in VA for lung cancer each year. In facilities without screening programs like LPOP, lung cancer isn’t usually detected until the more advanced stages that are harder to treat. 

In contrast, Veterans are usually referred to LPOP when their primary care team notes risk factors such as tobacco use. An LPOP lung cancer navigator assesses whether screening is necessary and will refer Veterans for CT scans and smoking cessation programs. A radiologist reviews the scans, and if signs of cancer appear, will schedule a lung biopsy, follow-up appointments, or cancer treatments. It is all together a far easier process for the Veteran than treatments for advanced-stage lung cancer would be.

“The satisfaction from the positive results of the program is enough to make everyone work harder,” Kheradmand said. “We’ve been able to put a team together that is proud of what they are doing. Everyone sees what their role is in the process to positively impact Veterans’ lives.”

LPOP is a component of VA’s larger Precision Oncology Initiative, which in turn is part of the White House’s Cancer Moonshot initiative. These initiatives aim to increase cancer screening and early detection, create target treatments based on genetics, improve inequities in screening and treatment access, and learn from all patients to improve cancer care across America’s healthcare system.