This podcast is produced for the Johnson & Johnson Lung Cancer Initiative by Scientific American Custom Media, a division separate from the journal’s board of editors.

In this episode, Mark Lloyd Davis, Global Head of Strategic Initiatives at Johnson & Johnson’s Lung Cancer Initiative, will discuss the importance of promoting health equity through early screening and open conversations about racial and social inequities, along with improved training on diseases.


Megan Hall: If you want to prevent lung cancer deaths, there’s an important first step: catch the disease early.

Scientists at Johnson & Johnson are developing tools to improve lung cancer detection in hopes of doing just that.

And this is where the work of Mark Lloyd Davies comes in. He is the global head of strategic initiatives at Johnson & Johnson, working directly with the Lung Cancer Initiative. And he’s dedicated himself to changing public policy so that the people most likely to develop lung cancer have access to the regular screenings they need.

Mark recently met with Scientific American Custom Media to discuss ways to reach these vulnerable populations earlier.

hall: We know that lung cancer is often fatal because it is detected too late. So you’d think there would be a lot of pressure to offer regular screenings, especially to smokers. Unfortunately, it is not.

Mark Lloyd Davies: There are few or no policy mechanisms that incentivize health systems to catch lung cancer at an early stage.

hall: Mark says that each year only about five to seven percent of people who qualify are screened for lung cancer.

Davis: And that’s in stark contrast, for example, to other cancers, like cervical cancer, where you have 80% of patients going through their annual cervical cancer screening.

hall: Why are lung cancer screenings so low if we know they would save lives?

Davis: I have attended many summits, meetings, discussions of leading clinicians, pulmonologists, oncologists, politicians, patient advocates, and there is not necessarily a single well-known answer as to why this is.

hall: But Mark has a few ideas. Number one: the “stigma” associated with smoking.

Davis: There is almost a sense of shame among people who are at risk of developing lung cancer, such as smokers. And as a result, there’s not as much of a proactive drive to seek out that annual lung screening and check my health regularly, etc.

hall: It’s as if the health care system has stigmatized smoking too much.

Davis: This is of course bad for people’s health – people shouldn’t do it. But if they are, that doesn’t suddenly mean that health support, the annual lung screening, shouldn’t be pursued. These patients should still receive their annual lung exam.

hall: Reason number two? Health inequalities. According to Mark’s research, heavy smokers or former heavy smokers who recently quit were also more likely to be black, earn less money and have less education. All these factors reduce their access to quality healthcare.

Davis: So basically the lower income and lower education groups are not getting the annual lung screening they should be getting.

hall: How to solve this problem? Mark says the answer lies not with the patients, but with the healthcare providers.

Davis: There is concern in the policy community how do we know how much our patients are really smoking? But this is in some ways an approach from the wrong angle and perspective.

hall: Instead of getting patients to be honest about their smoking habits, why not motivate doctors to offer proactive lung cancer screenings?

Davis: I think the best starting point to start moving the needle would be for policymakers and health system experts to develop a quality measure of lung cancer screening. Which will essentially incentivize providers to start providing more screening.

hall: The plan would work like this: If doctors and health care systems were rated based on their rates of lung cancer screenings, they would be more likely to identify eligible patients and give them those screenings each year. Additionally, lung cancer patient advocates can hold these health care providers accountable.

Davis: Buyers and consumers can start comparing provider plans and see, “Oh, this particular organization provides lung cancer screening and these don’t.”

hall: How close are we to this kind of measure of quality? Mark says a group of public, private and voluntary organizations called the National Lung Cancer Roundtable is very interested in this approach.

Davis: I’m really excited and pleased that the National Lung Cancer Roundtable, which had a lung cancer screening summit in Washington this July, has announced that it wants to work and take forward leadership on quality measure .

hall: Even before this summit, the Lung Cancer Initiative at Johnson & Johnson and an organization called LUNGevity brought together stakeholders at a high-level roundtable to consider the issue.

Davis: And one key breakthrough was that everyone agreed, yes, these screening rates are too low. So let’s start thinking about potential solutions. And then through this forum, through this dialogue, led to the proposal for a quality measure?

hall: Mark is excited to support these efforts and rate providers on their lung cancer screening rates. And if this work is successful, it will also help those like the Lung Cancer Initiative at Johnson & Johnson and others working to develop better screening tools — like blood tests or nasal swabs — to one day detect lung cancer.

Davis: As these new products become available to patients, there is a health system design that will allow these technologies to reach patients faster and faster.

hall: Making it work means aligning policy, research and technology. Mark’s hopes are that the efforts of the Lung Cancer Initiative will lead to a future in which vulnerable populations are screened more often, lung cancer is detected earlier and the disease is easier to treat. All in order to give cancer patients a better chance of survival.

Mark Lloyd Davis is the global head of strategic initiatives at Johnson & Johnson.

The Lung Cancer Initiative was established in 2018 to unleash the full potential of science and technology to change the trajectory of this complex disease.

This podcast is produced by Scientific American Custom Media and made possible through the support of the Lung Cancer Initiative at Johnson & Johnson.

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