Building a Lung Cancer Screening Program for a High Risk Population

background: In Libby, Montana, community-wide asbestos exposure resulted in EPA’s only Public Health Emergency declared under Superfund Law. Lung cancer is the number one cause of cancer deaths worldwide.  Asbestos exposure significantly increases lung cancer risk and coupled with significant smoking history, risk is exponentially increased in Libby’s asbestos exposed population.  Barriers to lung cancer screening include lack of: insurance coverage, established screening programs, and education about its benefits. In Libby, elevated poverty rates and geographic isolation also deter participation.  The Center for Asbestos Related Disease (CARD) follows ~2,500 individuals with asbestos related disease (ARD) and ~3,000 with asbestos exposure who receive ongoing screening for ARD and colon cancer.  objectives: CARD aimed to expand services to educate about benefits of lung cancer screening for early detection and grant access to affordable lung cancer screening for high risk patients.  methods: In 2012, CARD submitted a proposal to CDC/ATSDR to expand screening programs to include free lung cancer screening for high risk individuals.  The eligibility criteria were modelled after AATS guidelines.  Once funded, the first free low dose CT scan for lung cancer screening was done in February 2013.  results: To date, nearly 500 free lung cancer screenings and multiple referrals for significant medical findings have been done.  ~25% of ARD diagnosed patients seen for annual asbestos check-ups at CARD have participated lung cancer screening.  conclusions:  Outreach, education, smoking cessation, and participation in lung cancer screening have been successfully implemented and well received and will improve public health in the Libby community.