Advancing lung cancer screening initiatives in Kentucky

The Kentucky LEADS Collaborative has been working to advance lung cancer screening programmes in the US state.
 

Lung cancer in Kentucky: why is screening needed?

Kentucky has historically faced the highest rates of lung cancer incidence and mortality in the US.¹ Following the publication of the National Lung Screening Trial (NLST), researchers in the state saw an opportunity to improve outcomes through low-dose computed tomography (LDCT) screening.²

Lung cancer screening became a priority in the Kentucky Cancer Action Plan, led by the Kentucky Cancer Consortium. The consortium established the Lung Cancer Network to coordinate statewide efforts to reduce the incidence and mortality of lung cancer.²

With support from the Kentucky Cancer Consortium, an interdisciplinary investigative team – comprising members from the University of Kentucky, the University of Louisville and the Lung Cancer Alliance (now GO2 for Lung Cancer) – initiated a comprehensive, multi-level initiative aimed at addressing lung cancer in the state: the Kentucky LEADS Collaborative.²
 

The Kentucky LEADS Collaborative

The Kentucky LEADS Collaborative developed, implemented and evaluated a range of projects designed to decrease the incidence and impact of lung cancer, with a primary focus on advancing screening initiatives. To achieve this, it partnered with over 100 organisations and health systems statewide.²

One of the first statewide activities included a lung cancer screening roadshow that took place from 2013 to 2014. Its aim was to raise awareness of the benefits of screening by visiting 14 different regions of Kentucky, providing locally relevant information about lung cancer, introducing the upcoming launch of lung cancer screening programmes, and responding to clinician and community questions.² The roadshow directly reached hundreds of clinicians and community members, and thousands more due to extensive media coverage.⁴ Its success highlighted a significant interest in screening among clinicians and the community.

Another area of focus for the collaborative is quality management and improvement; it has therefore designed a system to support the delivery of high-quality lung cancer screening. The system does this by enhancing screening programme policies, procedures and delivery to optimise engagement and outcomes. So far, 10 lung cancer screening programmes in Kentucky have used the system,³ which has allowed them to perform 9,893 LDCT scans during the project period.²

The system:²

• assesses screening programmes and measures how well they align with best evidence of effective delivery and results, assigning them a corresponding score
• feeds back the score analysis and suggested changes to service delivery to improve participant engagement and outcomes
• provides materials and training for clinicians and staff to use in improving programmes.

The system employs cost-effective approaches intended to improve outcomes, offering both financial support and expert guidance for establishing sustainable initiatives.² Using the system has allowed the collaborative to expand access to screening across the state, with a focus on rural communities that face higher rates of lung cancer.²
 

Project impact

Through the Kentucky LEADS Collaborative, the state has become a national leader in lung cancer screening participation, with a rate of 13.7% in 2020⁵ – four times higher than states with similarly high lung cancer mortality. In 2024, the American Lung Association’s State of Lung Cancer report found that the early diagnosis rate in Kentucky had improved by 14% in the previous five years.⁶ Another factor in these improvements is thought to be the expansion of Medicaid in the state in 2014, which allowed more people with low incomes to qualify for lung cancer screening.⁷

Since the initiation of the collaborative’s activities in 2014, the state experienced a 10% decrease in late-stage (stages III and IV) lung cancer diagnoses through 2019, a decline that was twice the national average.⁸ The Appalachian region of Kentucky saw an even greater reduction, with rates falling at three times the national average.²

Over the 18-month implementation period from 2018 to 2020, the quality management and improvement system significantly enhanced the quality of programmes it has been applied to – notably in lung cancer risk reduction, shared decision-making, retention levels, and community outreach and engagement efforts.² Preliminary analyses indicate that regions supported by the collaborative achieved significantly higher participation rates compared with those not involved in the project.² The change has been especially significant in rural Appalachia; in 2023, Appalachian Regional Healthcare screened over 3,000 participants compared with just 372 in 2017.⁷

These outcomes demonstrate that, with strategic collaboration, targeted investment and evidence-based tools, even locations with historically high lung cancer mortality can lead the way in screening optimisation.

The quality management system has been revised to emphasise reach, recognising the differences among individuals and communities eligible for lung cancer screening and highlighting the need to consider various factors that may affect participation in these programmes.²
 

Next steps

While the quality management system used in the Kentucky LEADS Collaborative is currently designed to support active screening programmes, future iterations may aim to assist in the creation of new ones. The system is being extended to support lung cancer screening efforts in different regions of the US, and potentially beyond:²

• expansion is underway in Kentucky, supported by a grant from the Kentucky Department of Public Health
• implementation is planned in Mississippi and Nevada with support from the Bristol Myers Squibb Foundation
• there is a long-term ambition to scale the system across the US
• while the system is broadly applicable, it is based on US-specific policies and may require adaptation for use in other countries.