#LCSM Chat Topic 2/26 at 8PM ET: Changing the Language of Cancer

Cancer is a gift.
Cancer is a battle.
I’m cancer free.
G-d only gives you what you can handle.
Stay positive.
These are words and phrases often associated with a cancer diagnosis. Are they helpful or not?

Obesity is the new smoking.
Limit alcohol consumption.
Exercise more.
Sit less.
There have been countless media reports about cancer prevention. Good advice, right?

Treatable vs. curable.
‘Good’ cancer vs. ‘bad’ cancer.
5-year survival.
Surgical cure.
These are examples of language that may be heard in doctor’s offices. Are health care providers and patients on the same page?

Join moderator Laronica Conway @louisianagirl91 for #LCSM Chat on Thursday, February 26, at 5 PM PT, 7 PM CT, 8 PM ET, as we discuss the language of cancer, what works, and what can be changed for the better.

T1: What do patients want to hear from friends, family and the general public? What doesn’t help?

T2: What do you think of cancer prevention messages? Good advice, or patient blaming?

T3: How can health care providers and patients/caregivers communicate more clearly with each other?

We look forward to seeing you Thursday 2/26 at 8 PM ET.  Please be sure to include #LCSM in your tweets to participate in the chat.  For more about how to participate, see our #LCSM Chat Primer.

#LCSM Chat Topic 2/12 8PM ET: #IWishMyDoc and #IWishMyPatient

Stacey Tinianov (@coffeemommy) wrote an excellent blogpost titled “Context, Understanding and Empathy: #IWishMyDoc & #IWishMyPatient” on the Flip the Clinic website February 1. Below are excerpts from that post that set the stage for our next LCSM Chat on February 12:

If you could openly offer any suggestion to your physician, what would it be and why?

If you could kindly suggest something that could improve your patient’s time in the clinic or overall health, what would you tell them?

Although whole health and wellness is the goal for both physicians and patients, we occasionally seem disconnected from—or even at odds with—each other. A health care provider’s best intentions can be crushed by time constraints. A patient’s desire to be well can get lost in the mix of misunderstanding.

In an effort to help provide context, improve understanding, generate empathy, and drive a change in behaviors between physician and patient, let’s make these wishes visible. In the month of February, with the hashtags #IWishMyDoc and #IWishMyPatient, we can start a respectful conversation, aimed at bridging the gap between patient and physician, with health, wellness, and shared understanding at the center.

The #LCSM Chat on February 12, 2015, at 8 PM Eastern Time, will support Stacey’s effort by fostering a respectful conversation that aims for shared understanding.  In a change of format for this chat, we will not have formal topics T1, T2, etc.  Instead, your moderator Janet Freeman-Daily (@JFreemanDaily) will post prompts to encourage you to share your wishes using the hashtags below in your tweets in addition to the #LCSM hashtag:

  • #IWishMyDoc
  • #IWishMyPatient
  • #IWishMyNurse
  • #IWishMyHospital
  • #IWishMyInsurer

We’ll introduce ourselves during the first five minutes, then you can tweet any of these hashtags at any time during the one-hour chat.  Please remember to include #LCSM in ALL your tweets so the other chat participants can see them.  You can read a primer on participating in the chat here.

Sample tweets to get you thinking (remember, be respectful – no blaming!):

  • #IWishMyDoc would offer to call me in evening after my scan with results so I won’t worry over a weekend  #LCSM
  • #IWishMyPatient would tell me when they don’t understand a term I’m using so I can clarify it during the visit. #LCSM
  • #IWishMyNurse would send me a follow-up email a few days after an office visit to see if I have questions.  #LCSM
  • #IWishMyHospital would make scan report available online via patient portal after patient and doc discuss it. #LCSM

Stacey will be collating responses collected via Twitter throughout February, and will share the results.  We look forward to seeing you in the chat!

#LCSM Chat Topic 1/29 8PM ET: How Do Patients Decide Where to Seek Cancer Treatment?

Cancer is both a terrible, terrifying disease and big business.  With costs of care rising and delivery of medicine changing, independent private practice groups are increasingly uncommon and sole practitioners are rare.   Cancer care is now becoming consolidated as a system of larger institutions and networks, whether academic or private. And they build business with marketing and a keen eye on competition.

These institutions are targeting market niches with major campaigns. Smaller, local centers may focus on the opportunity to get cancer care close to home. Other centers feature cutting edge care and clinical trials. Still others highlight integrative care and holistic, emotional support.

So … how does a patient choose where to go for treatment?  Are the treatment methods effective?  How do the facility’s results compare to outcomes elsewhere?  How can you determine if the care is as good as the facility claims?

Our upcoming #LCSM tweet chat on Thursday, January 29 at 8PM ET/5PM PT will address what impacts cancer patient decisions about where to receive care. Obviously, different people select all kinds of cancer centers because they prioritize different things. So we’ll turn to questions around marketing cancer care and how important and effective it is. Specifically, moderator Dr. H Jack West will help us explore the following questions during the hour:

T1: What factors are most important in deciding where to seek cancer care? Referring doc? Friends? Marketing? Web ratings?

T2: Do you believe marketing claims about cancer care? What impressed? Disappointed?

T3: Many marketing campaigns are case testimonials. Are personal stories still more effective than stats?

T4: Does access to newest drugs, technology and clinical trials motivate patients to drive >1 hr or get on a plane?

T5: Do most patients make the best choice for their care? Are some misled by bad referrals or inaccurate advertising?

To join, just search for hashtag #LCSM during the hour of the chat and add “#LCSM” to your tweets to add comments (or go to tchat.io and sign in). Hope to see you there!

References

Do Billboards Influence Cancer Decisions?

Is Cancer Hospital Advertising Misleading Patients?
(access requires free registration on Medscape)

#LCSM Chat Topic 1/15 at 8PM ET: “Should the FDA Regulate Which Cancer Tests You Can Have?”

The US Food and Drug Administration (FDA) announced its intention to regulate laboratory developed tests.  Under the FDA’s proposed Framework for Regulatory Oversight of Laboratory Developed Tests (LDTs) — which treats LDTs as medical devices and healthcare providers as manufacturers — laboratories would have to submit applications for expensive premarket review for thousands of LDTs if they wish to continue offering them to patients.  This could limit access to life-saving genomic testing for patients who have cancer and other conditions treatable with targeted drugs.

This Thursday, January 15, 2015, at 8 PM Eastern, the subject for #LCSM Chat will be “Should the FDA regulate which cancer tests you can have?”  We invite patients, caregivers, doctors, researchers, professional societies, advocates, and regulators in all cancer communities to participate in this discussion.  Your moderator will be Janet Freeman-Daily.

Our discussion topics:

  • T1: What info about an LDT would give you confidence that it accurately identifies cancer or treatable mutations?
  • T2: Does FDA approval ensure accuracy and usefulness of LDTs? What other info/oversight could do this?
  • T3: Would FDA regulation of LDTs interfere with the practice of medicine?
  • T4: Should only FDA-approved LDTs be used to guide treatment of cancer patients?  Why or why not?

Background information about subject is below.

We look forward to seeing you Thursday 1/15 at 8 PM.  Please be sure to include #LCSM in your tweets to participate in the chat.  For more about how to participate, see our #LCSM Chat Primer.

 

BACKGROUND

Laboratory developed tests (LDTs) are developed, validated, performed and interpreted by trained professionals in hospital, academic, and commercial laboratories.  Examples of important LDTs for lung cancer patients include blood tests (blood count, liver function, cancer biomarkers), identification of biopsied cell types (e.g., adenocarcinoma, small cell lung cancer), molecular tests (EGFR, ALK, ROS1), and genomic panels (which can test for over 200 cancer-causing gene mutations and rearrangements from one set of tissue samples).  While some tests are automated, the results of these tests often depend on the judgment and skills of medical professionals such as MD pathologists or PhD scientists.  Cancer-related LDTs are often developed at the request of (and in consultation with) oncologists to allow physicians to tailor treatments for their patients.

LDTs that are performed in your hospital’s lab or commercial labs (like Foundation Medicine) typically are not regulated by the FDA.  However, labs are regulated and certified by the Centers for Medicare and Medicaid Services through Clinical Laboratory Improvement Amendments (CLIA), state health agencies, and organizations such as the College of American Pathologists.  They also participate in programs such as proficiency testing to ensure accuracy.

Unlike LDTs, tests that are boxed and shipped to other labs and professionals contain all of the components and information necessary to perform the test outside of the laboratory in which it was designed and manufactured.  Because they are manufactured by a company and not developed and validated by health professionals as part of a medical service, test kits are regulated by the FDA. The BRAF test manufactured by Roche is an example of an FDA-regulated kit.

Under the proposed framework for regulation of LDTs, the FDA would regulate LDTs just as they would medical devices such as stents, blood glucose monitors or hip replacements.  Regulations would vary depending on risk categories, with tests that determine patient treatments considered as “high risk.”  If this proposal were finalized, in many cases laboratories would have to pull their LDTs from their list of patient services or submit them for review by the FDA.

At first glance, FDA regulation of LDTs might seem like a good idea.  The number of commercially available LDTs to detect mutations in cancer tissue has exploded from a handful in 2011 to dozens today.  Some people argue we need regulations to protect vulnerable patients, citing as one example the Ovasure LDT for early detection of ovarian cancer, which the FDA forced off the market in 2008.  The test aimed to detect specific proteins in the blood that, when analyzed via a mathematical algorithm, could determine whether the patient had ovarian cancer.  However, the LDT was marketed before its accuracy was validated in a large group of patients.  As a result, Ovasure false positives caused some women to have their ovaries removed when they did not actually have ovarian cancer.  We need to prevent such things from happening, right?

Yes, we want LDTs to be as accurate and clinically useful as possible.  But FDA regulation will not change the fact that ALL tests, whether an LDT or test kit, occasionally have false readings.  Early in my cancer journey, a blood test said my blood glucose was 30-something (normal range is 70-120).  The doctor called me late at night, concerned that I was seriously ill (if not dead).  I was fine.  The test result was incorrect.

The FDA held a workshop on the proposed regulations on January 8-9, 2015 (see agenda day 1 and day 2 videos).  During the two days of presentations, several issues were raised :

  • PACE of scientific discovery: Our knowledge of cancer-causing genes, how they affect the body, and ways of detecting them is evolving rapidly. FDA regulations move slowly; approvals usually takes years.
  • VARIETY of labs producing LDTs: Some large for-profit labs that offer genomic tests might be able to afford the cost of additional personnel and fees to comply with proposed FDA regulations. Smaller labs such as those associated with hospitals might not be able to absorb the additional costs and might be forced to close.
  • SCOPE of tests: Determining which LDTs to perform, validating results, and applying the results to treatment is the practice of medicine, which the FDA is prohibited from regulating. Also, the FDA seeks to regulate LDTs as medical devices, but laboratory professionals claim LDTs are not medical devices because they involve medical judgment.

Our understanding of existing oncogenes (ALK, EGFR, BRAF, etc.) and their associated targeted therapies continues to evolve even after the FDA approves companion tests to detect targetable mutations.  It’s not unusual for an LDT to be developed that detects a new variation of an oncogene not detected by the FDA-approved test.  Must cancer patients wait years until the FDA approves the new LDT before they can receive an effective targeted therapy?  Most stage IV cancer patients can’t afford to wait that long.

Here’s an example of how pace, variety, and scope can make a difference for patients.  In a presentation to the FDA on January 8, University of Colorado pathologist Dara Aisner, MD, PhD, shared the following:

“This Kaplan-Meier Curve demonstrates survival benefit for patients with metastatic melanoma treated with vemurafinib [vs dacarbazine] when they have an ‘atypical’ mutation – V600K.  Of note, 34% of the V600K mutation positive patients in this cohort were classified as NEGATIVE by an FDA approved assay and were only detected using a non-FDA approved assay. … This is an example of the clinical validity that evolves rapidly with time.  Determining clinical validity is the physician’s job.”

 Survival Analysis of patients with BRAF V600K mutation

As you can see from this example, restricting the targeted therapy vemurafinib only to patients identified by the FDA-approved test would have prevented many patients from receiving effective treatment.  The current FDA approval process takes years, is resource intensive, and could potentially interfere with the practice of medicine.  Dr. Aisner has stated that if the FDA’s proposed regulations are enacted, her lab at the University of Colorado might have to close or at least stop providing many of its tests.

Another example: the current FDA-approved test for detecting ALK rearrangements in lung cancer is only approved for testing biopsied tumor tissue.  If a patient doesn’t have sufficient biopsied tissue for testing, sometimes other sources of cells (such as fluid collected from a pleural effusion or a lymph node) can provide enough cells for ALK testing.  Many labs have independently validated the test on such specimens.  However, under the proposed FDA regulations, testing these alternative specimens would no longer be allowed unless a lab submits the test to the FDA and obtains its approval.  As a result, some lung cancer patients would have more limited options for testing, and might require additional, potentially dangerous biopsies in order to obtain tumor tissue.

Note that the proposed regulations include an exemption for LDTs for unmet needs that would allow the use of non-FDA reviewed LDTs when no approved LDT is available for the condition.  For instance, ROS1 NSCLC (my diagnosis) does not have an approved LDT, so patients could be tested with an unapproved LDT.

This proposed regulation has the potential to prevent targeted therapy treatment for thousands of patients with cancers and other diseases.  We hope you’ll join us for #LCSM Chat on Thursday January 15 at 8 PM.

Comment period for the proposed FDA Framework for Regulation of Laboratory Developed Tests (LDTs) closes on February 2, 2015. Please let the FDA know what you think by submitting your comments ASAP to http://www.regulations.gov (be sure to include the docket number FDA-2011-D-0360). You can also submit comments electronically here .

REFERENCES

Overview Articles:

Opinions Divided on Proposed FDA LDT Regulations (Genetic Engineering and Biotechnology News)

To regulate or not: FDA hears arguments on medical tests (New England Center for Investigative Reporting)

 

Supporting the FDA’s Proposed Framework:

Advamed (medical device manufacturer’s trade association)

American Association of Cancer Research

American Cancer Society Cancer Action Network, American Heart Association, and Ovarian Cancer National Alliance

American Society of Clinical Oncology

Journal of American Medical Association (yes)

 

Opposing the FDA’s Proposed Framework:

American Clinical Laboratory Association

ARUP Laboratories

Association for Molecular Pathology (white paper)

Joint Letter to FDA (signed by 51 organizations, societies, and laboratory directors)

Journal of American Medical Association (no)

#LCSM Chat Topic for 12/18 8PM ET: A Year-End Focus on the Highlights of 2014

For our last #LCSM tweet chat of the year, this Thursday, December 18th at 8 PM ET/5 PM PT, we’ll do a retrospective reflection on the biggest developments of 2014. It was a pretty good year for lung cancer, so I’ll offer up my view of the top 5 changes over the past year and welcome group discussion on whether these fall in line for others.

Dr. West’s Top 5 Highlights in 2014

1. Rapid development of immune checkpoint inhibitors for lung cancer: We haven’t seen a PD-1 or PD-L1 inhibitor approved by the FDA for lung cancer yet, but immunotherapies have only continued to gain momentum and street cred as multiple new agents show comparable activity in a subset of patients. Though it’s not most patients, the ones who respond often respond very well and for a very long time. Multiple companies are tripping over themselves trying to study these immune checkpoint inhibitors in every clinical setting and in combination with every other treatment for lung cancer. These agents are approaching escape velocity for lung cancer.

2. We broke the impasse against acquired resistance for both ALK and EGFR mutation-positive patients: The FDA approved Zykadia (ceritinib) for XALKORI-refractory ALK-positive NSCLC, and the evidence shows it is even more active for XALKORI-naïve patients. It also has clear activity against brain metastases, an Achilles heel for XALKORI over the past several years. Now with multiple generally well-tolerated and very active additional second generation ALK inhibitors moving through clinical testing, we are at the cusp of having an enviable choice of options and potentially soon being able to select particular agents for particular ALK mutations.

Though we don’t yet have a new agent for acquired resistance in EGFR mutation-positive disease commercially available, both AZD9291 and rociletinib (CO-1686) broke out as among the biggest stories at ASCO 2014. The trials with these agents are rolling out worldwide, and we should hope and expect to see one of these become commercially available in the not too distant future.

3. Genomic testing goes mainstream: Though broad “multiplex” testing of a multitude of genes in one panel hasn’t yet delivered on its great promise, since there aren’t yet enough “actionable” mutations to help most patients, this testing, as offered by Foundation Medicine, Caris, and many other large labs is rolling out everywhere. I see this as a big investment in the short term and long term future for cancer treatment. Without knowing exactly where it will lead us, the availability of broad multiplex molecular testing and “next generation sequencing” platforms make most people treating cancer feel that we’re entering a new era of both understanding and treatments matched to the cancer. It will also lead to a new classification of cancer based more on the mutation(s) seen in the cancer than the anatomic definition of a cancer based on its tissue of origin.

4. Modest gains for big populations with advanced non-small cell lung cancer: The median survival benefit seen with the addition of Cyramza (ramucirumab), an antiangiogenic antibody administered every 3 weeks, to Taxotere (docetaxel) on the REVEL trial can’t be considered revolutionary, seeing any treatment move the needle for previously treated patients is a welcome change. This is especially true when this approach includes the oft-excluded patients with squamous NSCLC. The study was enough to lead to the approval of Cyramza in lung cancer by the FDA just in the last few weeks. This year also saw the approval in the EU of Vargatef (nintedinib), an oral anticancer therapy that also blocks angiogenesis, in combination with Taxotere for patients with advanced lung adenocarcinoma, based on an approximately 2 month improvement in median survival with the combination of Vargatef with Taxotere on the large phase III LUME Lung-1 trial.

5. CMS approves low dose chest CT (LDCT)screening for high-risk Medicare patients, with stipulations. After a year of active debate and campaigning over the cost and anticipated benefits vs. risk of widespread screening of higher risk patients (age 55-74, 30 “pack-year” or greater smoking history, current smoker or quit in last 15 years), the Center for Medicare and Medicaid Services (CMS) finally voted to approve LDCT screening for the specific population studied in the large NLST study that demonstrated a significant survival benefit. This approval was accompanied by unprecedented restrictions that included a strict mandate about patients conforming to the age and tobacco exposure requirements specified, including detailed counseling about the high potential for ambiguous lung nodules and the need for smoking cessation counseling, and a restriction of approved LDCT screening to the centers that had developed experience with it in earlier screening trials.

There has been significant debate about whether these limitations will do more to enforce best practices and high quality screening or serve as a barrier for appropriate candidates to pursue screening. This debate also includes questions of the true intent of the seemingly lofty goals, which should help to also limit costs for coverage. But seeing validation of the concept of LDCT screening for appropriate patients after so much skepticism represents a victory for the lung cancer community that will definitely lead to a reduction in deaths from lung cancer and a shift to far more patients being treated at an earlier stage of disease.

Please join us for this important last #LCSM chat on Thursday – we’d love to learn your perspective about these topics and others that you think should be considered as major highlights in lung cancer in 2014. And after a break on New Year’s Day, we’ll pick up again on January 15th with a chat that focuses on predictions and a wish list in lung cancer for 2015.

Check it out Thursday, December 18th, 8 PM ET/5 PM PT at http://www.tchat.io/rooms/lcsm or filter by #LCSM on twitter and add it to your tweets during that hour. Hope to see you then!

#LCSM Chat Topic for 12/4 8PM ET: “CMS lung cancer screening rules: overboard, or on the mark?”

The topic for #LCSM Chat on Thursday, December 4, 2014 at 8PM ET will be, “CMS lung cancer screening rules: overboard, or on the mark?”  Our moderator Janet Freeman-Daily (@JFreemanDaily) will lead our discussion using the topics below. You can learn more about #LCSM Chat and how to join it here.

  • T1: Do you agree with patient characteristics defined in CMS proposed lung cancer screening coverage?
  • T2: Do you agree there is potential harm in lung cancer screening at centers that don’t have counseling or extensive experience?
  • T3: Will CMS limitations channel patients to most qualified centers, or instead keep patients from lung cancer screening?
  • T4: Are limitations on lung cancer screening fair & appropriate compared to screening for other cancers?

BACKGROUND

On November 10, the US Centers for Medicare and Medicaid Services (CMS) issued a proposed decision to cover low dose chest computerized tomography (LDCT) lung cancer screening for high-risk patients.  CMS is accepting comments on this proposed decision for 30 days, and will issue its final decision in February 2015.  Private health insurance policies that fall under the Affordable Care Act (ACA) are required by law to cover lung cancer screening with LDCT as of January 1, 2015.

The lung cancer community had worked towards this outcome for many months.  Over 70 professional societies, medical centers and universities wrote a joint letter to CMS in support of lung cancer screening; in it, they cited considerable medical evidence, and outlined the conditions under which screening should be implemented.  Eighteen lung cancer advocacy organizations wrote a joint letter supporting the Joint Societies letter.  A team led by the American College of Chest Physicians presented a policy to CMS on “Components Necessary for High Quality Lung Cancer Screening.”  The collaborative effort behind this decision was huge, and the entire community celebrated the proposed CMS decision.

According to Dr. Gerard A. Silvestri, President-Designate of the American College of Chest Physicians, lung cancer screening will save one life for every 256 people screened.  That’s similar to the stats for mammography.  He believes the greatest challenge in making lung cancer screening widely available is having programs available to manage nodules detected during screening.

Lung cancer screening is not without risk:  it’s likely to detect one or more nodules that may or may not be cancer.  If a nodule is found, the doctor may recommend follow-up imaging–doctors can use subsequent CT scans to determine whether a nodule is growing.  However, assessment of a nodule might require an invasive intervention like a biopsy, which might discover the nodule was not cancer.  To minimize harm to patients, only patients at high risk for lung cancer should be screened.  For now, that means never smokers are not eligible for screening because they are much more likely to have benign nodules than cancer.

Given recent controversy regarding screening criteria for other cancers, a key component of the CMS decision is to ensure the benefits of lung cancer screening outweigh the risks.  To reduce the risk, the proposed CMS decision sets specific restrictions on LDCT coverage:

  • Screening must be done at accredited facilities;
  • Scans must be interpreted by radiologists who meet certain requirements;
  • Patients must be: asymptomatic (have no symptoms of lung cancer), between the ages of 55-74, current heavy smokers or former heavy smokers who quit within the past 15 years, and healthy enough for surgery;
  • Patient must participate in counseling and shared decision making about the benefits and risks of screening, as well as smoking cessation (if appropriate); and
  • Screening results must be entered into a central registry.

Depending on one’s perspective, the proposed CMS decision can be seen as providing safeguards necessary to minimize the risks of lung cancer screening, OR as creating barriers that might keep high-risk patients from getting screened.  Some reviewers (e.g., Otis Brawley of the American Cancer Society) think CMS struck just the right balance between benefits and risks.  Others in the lung cancer community have raised concerns that the proposed decision is too restrictive.

Examples of concerns that have been raised about the decision are:

  • The CMS proposed decision sets 74 as the upper age limit for screening. Yet a recently-published study of a validated lung cancer risk model found the highest lung cancer risks were in people aged 65-80. NCI statistics say the 75-84 age group represents 27.9% of diagnosed lung cancer cases. Should the age limit for screening be higher, perhaps age 80?
  • The symptoms of lung cancer can be subtle (e.g., tiredness or a cough) and similar to symptoms of other conditions such as COPD or medication side effects. What does an “asymptomatic” patient look like in this context?
  • Requiring screening centers to be accredited reduces the risk of mistakenly labeling a benign nodule as cancer. However, the cost and effort of obtaining accreditation may limit the availability of affordable lung cancer screening to the CMS population. How can we make quality lung cancer screening widely available?

Thanks to Andrea Borondy Kitts and Dr. Jack West for their contributions to this blog post.

REFERENCES

  1. Centers for Medicare and Medicaid Services. Proposed Decision Memo for Screening for Lung Cancer with Low Dose Computed Tomography (LDCT). Accessed 12/2/2014 at http://www.cms.gov/medicare-coverage-database/details/nca-proposed-decision-memo.aspx?NCAId=274
  2. Joint Societies. (26-Sep-2014). Letter to CMS. Accessed 12/4/2014 at http://www.acr.org/~/media/ACR/Documents/PDF/Advocacy/Fed%20Relations/LCS%20Stakeholder%20Letter%2009%2026%2014_FINAL.PDF
  3. Lung Cancer Alliance. (8-Oct-2014). Letter to CMS. Accessed 12/4/2014 at http://www.lungcanceralliance.org/Screening/CMS%20/CMS-Letter-FINAL%20Lung%20Cancer%20Patient%20Advocacy%20Organizations.pdf
  4. American College of Chest Physicians. (30-Oct-2014). CHEST lung cancer experts present policy statement to CMS Committee on Coverage. CHEST website. Accessed 12/4/2014 at http://www.chestnet.org/News/Press-Releases/2014/10/CHEST-lung-cancer-experts-present-policy-statement-to-CMS-Committee-on-Coverage
  5. Brawley, O. (13-Nov-2014). CMS Got it Right in Lung Cancer Screening Coverage Decision. The Cancer Letter. Accessed 12/3/2014 at http://cancerletter.com/articles/20141114_2
  6. Tammemägi MC, Church TR, Hocking WG, Silvestri GA, et al. (2-Dec-2014.) Evaluation of the Lung Cancer Risks at Which to Screen Ever- and Never-Smokers: Screening Rules Applied to the PLCO and NLST Cohorts. PLOS Medicine. DOI: 10.1371/journal.pmed.1001764 Accessed 12/4/2014 at http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001764
  7. National Cancer Institute. SEER Stat Fact Sheets: Lung and Bronchus Cancer. (No Date). Accessed 3-Dec-2014 at http://seer.cancer.gov/statfacts/html/lungb.html

#LCSM Chat Topic 11/20 (8 PM EST): Know Your Radon Risk

What action would you take to protect your family if you suspected a killer was in your home?

Radon gas is odorless, colorless, and classified as a human carcinogen by the World Health Organization, US National Academy of Sciences, US Department of Health and Human Services, and US Environmental Protection Agency (EPA).
Approximately 21,000 Americans will die from radon-induced lung cancer this yearIndoor exposure to radon gas is the second greatest known risk factor for lung cancer.  Radon exposure is a threat significant enough that nine federal agencies worked together to release the Federal Radon Action Plan in 2013.

The topic for our November 20 #LCSM Chat (8 PM EST) will focus on understanding what radon gas is, how to determine your risk, and how to reduce your risk at home.  For this chat, we will be joined by some special guests:

Our moderator Janet Freeman-Daily (@JFreemanDaily) will lead our discussion using the topics below.  You can learn more about #LCSM Chat and how to join it here.

T1:  What is radon gas? Why should we care about it?

T2: How can people determine if radon is a concern for them?

T3: How can people reduce indoor radon gas levels in their homes and businesses?

T4: How can we help more people learn about dangers of radon gas and how to reduce their risk?

 Resources

Thanks to Dusty Donaldson of the Dusty Joy Foundation for help with researching information for this post.