Just over a decade ago, in 2013, the U.S. Preventive Services Task Force (USPSTF) recommended annual lung screenings for asymptomatic adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit smoking within the past 15 years. This was a significant step forward in raising awareness about the benefits of lung cancer screenings for high-risk populations. However, there is still a long road ahead. Currently, only about 50% of individuals diagnosed with lung cancer meet the screening eligibility criteria. These guidelines do not fully account for a multitude of factors, known and unknown, that can lead to a devastating lung cancer diagnosis – the leading cause of cancer death in the U.S.
MAS-EXPAND, a new study supported by a grant from the Bristol Myers Squibb Foundation (BMS Foundation), an independent charitable organization, aims to advance our understanding of who is at risk. Led by Dr. Jennifer Lewis, assistant professor at Vanderbilt University Medical Center’s Division of Hematology-Oncology and research physician, Geriatric Research, Education and Clinical Center at VA Tennessee Valley Healthcare System, MAS-EXPAND will explore whether veterans aged 50 and older who have ever smoked at least 100 cigarettes and have additional risk factors, including military exposures to burn pits, Agent Orange, ionizing radiation and others, should be considered a high-risk population for lung cancer. This research could potentially inform future screening guidelines.
When Lewis first learned about the National Lung Screening Trial, she was excited about the potential to save lives through early lung cancer screening. However, after surveying her peers, she quickly realized that the wider medical community did not share her enthusiasm for implementing lung cancer screening.
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“I was just kind of shocked. No one really was doing it. And when I went to go and talk to other primary care providers, I just didn't get much of a response,” explained Lewis.
Her determination to expand awareness of the potentially life-saving practice of implementing the new national screening guidelines led her to the U.S. Department of Veteran Affairs (VA) in 2018, where she co-led the VA Partnership to Increase Access to Lung Screening (VA-PALS) program evaluation. Supported by the VA’s Office of Rural Health and a grant from the BMS Foundation, VA-PALS was ahead of its time, offering lung cancer screening programs even before the full benefits were widely recognized. The program was such a success that lung cancer screening is now a mandated service provided to all veterans.
Now, Lewis is looking to address gaps in lung cancer screening research and inform future guidelines through the MAS-EXPAND research study.
Burn pits, open-air areas used on military bases to dispose of waste by burning, have become a focus of research due to their potential health risks. According to the American Cancer Society (ACS), environmental sampling of the air and soil near burn pits has documented the presence of several chemical compounds shown in studies to be linked with inflammation and body tissue damage, particularly in the respiratory tract.
Incomplete combustion of material in burn pits results in high volumes of toxic particulate matter (PM); and, according to the ACS, there is “extensive evidence that PM in air pollution is linked to heart disease, asthma, chronic obstructive pulmonary disease (COPD), lung cancer and an overall increased risk of death.”
For Lewis, this potential risk factor is personal. Her husband is a veteran of the Iraq war, where he was consistently exposed to burn pits.
However, despite the initial evidence, current research is not clear enough for governing bodies like the USPSTF to classify individuals exposed to burn pits as a high-risk population for lung cancer. Thus, whether to be screened outside of current guidelines is an active area of research within VA.
Over the next several years, MAS-EXPAND will recruit 1,400 veterans across seven VA medical centers to undergo annual low-dose chest CT scans. The hope is that detecting lung cancer and other diseases at earlier, treatable stages will produce enough evidence to inform future screening guidelines and potentially save lives.
"We hope to detect more lung cancers at earlier stages, when they are curable,” said Lewis, who has committed much of her career to informing lung cancer screening guidelines.
Apart from her personal connection with the veteran community, she is inspired to honor the work of Dr. Pierre Massion, who submitted the initial grant for this project before unexpectedly passing away in 2021. “We are continuing this work in his legacy and have taken the acronym for the study to be MAS-EXPAND in memory of him,” said Lewis.
Going forward, Lewis envisions MAS-EXPAND as a pilot that will pave the way for more inclusive and effective lung cancer screening guidelines, ultimately saving more lives.
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