To test for lung cancer, a person needs to get low-dose computed tomography screening, more commonly known as a CT scan. But that can be costly and time-consuming, just two reasons why less than 2% of those eligible in California ever get scanned.
The City of Hope and DELFI Diagnostics Inc. are trying out a new kind of screening for lung cancer that uses a simple blood test. They believe that this much more convenient and less costly testing will draw in more people for screening, and save lives through early detection and treatment.
“It is very frustrating to see such low adoption of lung cancer screening,” said Dr. Dan Raz, a thoracic surgeon at City of Hope in Duarte and director of the lung cancer screening program. “This test has a lot of potential, especially for people who have a lot of barriers to getting screened.”
Lung cancer kills more people than any other kind of cancer. About 150,000 deaths each year in the U.S. are from lung cancer alone. But about 98% of those eligible for the scan in California are not getting it. In the U.S., 94% are eligible but only about 6% are being scanned, according to City of Hope and its partner, DELFI.
Blood test will save lives
“It’s important because it will save lives through lung cancer early detection. Finding it early will reduce the chances people will die,” explained Dr. Peter Bach, a former pulmonary and intensive care physician at Memorial Sloan Cancer Center in New York and now the chief medical officer at DELFI.
“The challenge we have had, even though (a CT scan) is covered by insurance, it is not particularly convenient and has not been used at rates of other screening tests” for other types of cancer, Bach said.
The CT scans are often hit by delays, plus the lack of same-day or weekend testing. The scans take several hours or often half a day, and many people can’t or won’t take time off from work. Health insurance delays and transportation to a hospital or clinic also create barriers, Raz said.
Getting the right preventative care at the right time can mean the difference between life and death. Lung cancer is often found by accident, while a patient is getting treatment for unrelated conditions, Raz said.
“We know that if we successfully get to patients, our tests will help identify who should get a CT scan. It can prevent 10,000 deaths in the United States if fully implemented,” Bach said.
Testing in Antelope Valley and Pomona
So when City of Hope teamed up with DELFI, they began focusing on high-risk populations, such as those who smoked cigarettes for years, as well as low-income socio-economic populations with barriers to healthcare.
Starting in late April, a mobile testing unit was sent to the Antelope Valley. The team is also signing up people for the blood test at the ParkTree Community Health Center in Pomona. The test is offered free of charge to eligible trial participants.
The City of Hope’s mobile screening clinic truck. In April and May 2024, the cancer hospital and research center began its blood testing program for lung cancer through the mobile unit in the Antelope Valley. Another site is in Pomona. (photo courtesy of City of Hope)
Other areas are also beginning trials. In Baltimore, Johns Hopkins Hospital has begun a similar pilot program, said Dr. Panagis Galiatsatos, a pulmonary and critical care doctor who is a co-investigator of the DELFI blood test at Johns Hopkins and a spokesperson for the American Lung Association.
Galiatsatos said the blood test adds another tool for detecting lung cancer. “The intention is to make lung cancer diagnosis better,” he said on Wednesday, May 29. “So having a biomarker (from the blood test) can get at cancer in real time. It gives clinicians a bit more confidence when we talk to patients.”
Here’s how it works
First, doctors say it’s important to note that the blood test tells patients they may have lung cancer. It does not tell people they have cancer. Instead, for those found to have biomarkers, doctors direct them to get a CT scan, the gold standard of lung cancer screening.
The blood test can be done in conjunction with other doctor visits for blood screenings, for cholesterol or blood sugar levels, for example. Only one vial of blood is needed. And City of Hope can send a team to your home if you don’t have transportation, Raz said.
Clinicians look at genetic material specific to lung cancer, Raz said. “It looks for lung cancer cells and the patterns of fragments of DNA” floating in the blood, he explained.
“It’s like Where’s Waldo,” said Dr. Bach with DELFI. “We are looking at the way the DNA has been chewed up into fragments.”
Battling public resistance
But as with many new inventions, getting the general public to accept them can be a challenge.
People in Black communities may not trust doctors or government tests, said Rich Wallace, president and CEO of the Southern California Black Chamber of Commerce.
“These people don’t want to be tested. Black people don’t trust doctors. They also don’t want to be a guinea pig,” said Wallace on May 28.
Testing by the government in a 1932 study originally called the “Tuskegee Study of Untreated Syphilis in the Negro Male” of about 600 Black men, including 201 who did not have the disease, was done without the participants’ informed consent, according to the Centers for Disease Control and Prevention. In 1972 the study was called “unethically justified.”
“We have a distrust especially when we hear the word ‘test,’ ” Wallace said.
Darryl Jackson, pastor of Love Chapel Life Changing Ministries in Ontario, said he and his congregants are not worried about being tested. They were part of a five-year Inland Empire Smoke Out program in which they learned about the dangers of smoking and the fact that it causes lung cancer. His congregation is 95% smoke-free.
“Yeah, I think that may be something my people would be interested in,” Jackson said. “Something where people can get a blood test and then, especially if they can catch it early.” He said he would tell his congregation to go to the clinic in nearby Pomona.
City of Hope and DELFI are aware of the reasons that prevent people from signing up, and that’s part of the program — providing ways to break down barriers.
Some who have smoked for many years see that as a stigma and don’t want to admit it, according to surveys done at the clinic sites, said Raz. “They say ‘I am afraid of being judged for having smoked,’ ” he said. Another barrier is that people just don’t want to know.
“In the Black community, for some reason, we have a concept that goes like this: ‘If I don’t go, I won’t know.’ There is a fear of doctors,” Jackson said. In the program, he heard from smokers and those who’ve quit who say they will just wait and see what happens. “It can be procrastination in taking care of our bodies.”
Raz said that often when symptoms arise, it is too late to save the patient’s life.
He said they will provide transportation to the blood test site and to the CT scan appointment. They will work with Medi-Cal patients for clearance, or with employers to provide a day off. If the participant doesn’t have insurance, they can help pay the cost of the CT scan.
Overcoming social resistance to tests, doctors and scans takes a constant effort, especially in low-income, minority communities, said Galiatsatos. But it can be done by talking first to influencers such as rabbis, priests, pastors and imams, who in turn inform their congregants.
“You do it with good advocacy,” he said. “We must help individuals overcome social factors in order to keep them achieving the health they are promised.”
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