Lung cancer risk for our military veterans is significant. This is because many smoked or had significant exposure during their service to toxic environmental hazards such as burn pits. The US Department of Veteran Affairs (VA) estimates that each year, the Veterans Health Administration diagnoses and treats approximately 8,000 veterans with lung cancer. Because VA also estimates that nearly 1.5 million veterans are at risk for developing lung cancer due to age and smoking status alone, VA supports broad lung cancer screening implementation programs to improve early detection. VA also supports innovative clinical trials to identify new treatment options for lung cancer.
To support VA’s efforts, LUNGevity Foundation launched a VA Research Scholar Award Program in 2022. This program supports research fellows planning to pursue a career in lung cancer research at a VA medical center or an academic institution affiliated with a local VA facility.
To learn more about the ways LUNGevity and VA are improving lung cancer outcomes for veterans, LUNGevity spoke with Drew Moghanaki, MD, MPH, co-director of the VA Greater Los Angeles Lung Precision Oncology Program, professor and chief of thoracic oncology at the UCLA Department of Radiation Oncology, and a valued member of LUNGevity’s Scientific Advisory Board.
LUNGevity Foundation: Please tell us about VA’s healthcare system.
Dr. Drew Moghanaki: Institute-designated VA currently provides healthcare for more than 6 out of 17 million veterans in the US. The number served through VA healthcare is likely to grow significantly in the near future following the PACT Act* which was signed into law on August 8, 2022. Eligible veterans have access to over 1,400 medical care sites including hospitals and community clinics. Some of these VA facilities are small rural clinics while others are located in metropolitan cities with academic affiliates that have a National Cancer Institute designated Cancer Center. Military veterans can check their eligibility for VA healthcare benefits by applying online (https://www.va.gov/health-care/how-to-apply/ ).
LF: What should a veteran with lung cancer expect if they choose to receive care at a VA medical center?
DM: Veterans with lung cancer who are eligible for healthcare benefits are generally referred to one of the major VA medical centers where cancer services are concentrated…Those who receive care from VA are generally managed by board certified specialists in pulmonology, thoracic surgery, radiation oncology, and medical oncology. VA has a National Precision Oncology Program that ensures all veterans have access to cutting edge molecular tests to help their doctors decide the best treatments for all types of cancers.
Treatments for lung cancer are delivered with state-of-the-art technologies like video-assisted thoracic surgery, high-precision radiation therapy, and the latest FDA-approved drugs including targeted therapies and immunotherapies. Veterans also have access to life-saving clinical trials that include therapies not yet available to the general public that can sometimes be the only therapeutic option for their diagnosis. Whenever the best medical care is unavailable, VA is authorized to partner with community practices to ensure timely access to state-of-the-art oncology care.
LF: Does VA have a dedicated program to increase access to early detection lung cancer screening for veterans?
DM: I’m glad you asked. VA has been a leader in developing strategies to identify lung cancers at an early stage when they are most likely to be curable. The history dates back to the 1950’s when VA partnered with the American Cancer Society to conduct the first early detection study with chest x-rays and sputum samples. More than half a century later, we know that annual low-dose chest CT (LDCT) scans offer the best way to detect lung cancer early. As a result, dedicated resources have led to the development of a National Center for Lung Cancer Screening that supports all VA medical centers across the country to ensure equitable access to high-quality lung screening with LDCT scans for veterans at risk for lung cancer. The exact number of veterans undergoing lung screening through LDCT scans each year is currently being determined, but we know it’s well over 10,000 a month and gradually rising each year.
LF: How does VA decide which veterans to screen for lung cancer?
DM: VA generally references the US Preventive Services Taskforce (USPSTF) guidelines to define its cancer screening policies. Yet, VA is authorized to create its own screening criteria if there is strong evidence that supports a modification to current USPSTF criteria that can improve outcomes without increasing the potential harms of unnecessary diagnostic procedures in veterans without lung cancer. For this reason, scientists at VA are exploring whether certain toxic exposures during military service on training bases, or in the field of battle, warrant broader lung screening criteria for our veterans. I look forward to seeing these data emerge, especially as we enter a new era where VA is prioritizing the importance of understanding the effects of toxic exposures on our soldiers who served in the military following approval of the PACT Act.
LF: LUNGevity launched the VA Research Scholar Award just this past year. Can you share your thoughts about how this helps scientists interested in lung cancer research within VA?
DM: VA is a national treasure with a rich history of medical research and discovery. The commitment of LUNGevity’s VA Research Scholar Program provides important resources to help us recruit, train, and retain promising young investigators who are seeking to develop careers in both lung cancer research and clinical care in VA. It’s a brilliant investment, as LUNGevity awardees who successfully develop a portfolio of veteran-focused research studies are positioned to pursue sustainable sources of funding from the VA Office of Research and Development to continue their work to help improve care for our veterans.
LF: What is your vision for veterans facing lung cancer in the future?
DM: I share LUNGevity’s vision of a “world where no one dies of lung cancer”. I truly believe this day will come for our veterans and all people at risk. However, we have a lot of work to do, and I’m proud of VA’s endless commitment to supporting important lung cancer programs. Our menu of lung cancer clinical trials for veterans is continuing to expand with the support of the Lung Precision Oncology Program. And, it’s my belief that the creation of the National Center for Lung Cancer Screening will eventually lead to a day when the majority of veterans (and all Americans) diagnosed with lung cancer will have early-stage disease amenable to cure with either minimally invasive surgery or radiation therapy.
*The PACT Act is officially called “The Honoring our Promise to Address Comprehensive Toxics Act of 2022.” It was signed into law by President Biden with the intention to improve healthcare access for veterans who were exposed to toxic substances during military service.