Thank you for the opportunity to discuss these four incredible presentations today. Sitting down trying to think what have we heard, what have we learned, what should we take home with us today. I guess first we have to ask ourselves, what are we even talking about? We're talking about equity, equity, what is it? One definition is, it is a state in which everyone has a fair and just opportunity to attain their highest level of well-being. Everyone opportunity their highest state of well-being. It's not the same thing as equality. Think about it, because equality actually in some ways promotes inequity. Two different people may not need the same solution. We are here excited because we know lung cancer is a big problem, and one of the biggest problems about lung cancer is it's a pretty expensive problem. I think we can start out saying something we can maybe all agree on, and that is nobody deserves lung cancer. Can we agree on that? I wasn't looking for applause. Then let me say something else that may be less readily open to applause. This is an epiphany I got two years ago from Laurie Fenton Ambrose at the National Lung Cancer Roundtable Annual Meeting. That is that lung cancer is not a science problem. It is a political problem. Let's chew on that for a second. Lung cancer is not a science problem. It is a political problem. What have we heard today? Sue Krengel told us about a population of lung cancer, a population in New Zealand with a much higher incidence and mortality risk from lung cancer. The striking image I got from her slide deck was where she showed in the Maori population the age stratified per capita incidence of lung cancer is much higher than in the non-Maori population with an equivalence at about 15 years separation. The 55 to 60-year-old Maoris, their incidence of lung cancer was equal to that of the 70-something year old non-Maoris. One example of a population in whom there is this problem to which we now have a solution. But as currently applied, the solution may be part of the problem. Come to that in a little bit. And then we heard from Shannon about another population of patients, another population of people who are at maybe we think higher risk for lung cancer than average. Maybe we think, well, because we don't know. Why don't we know? Because we don't measure. We don't even ask. Don't ask, don't tell. Maybe it's still lingering with us. You can't improve what you don't measure. So if we choose as a society that we will not ask because we don't want to know, then we are in danger of having a population with a high burden of something to which we maybe have a solution that we are unwilling politically to apply. And then we heard from Ephraim about when you have a program and you have a population at risk to whom you really don't have access, how do you go about engaging them to bring solutions to them? And the key words I heard was, the key words I heard were, meet them where they are. Meet them where they are. Engage them. Be humble. Don't think you know. Ask them, why, what do you need? Here's this thing. Here's this problem. We've got a gap between what we think you need and the solution we have, and we're not able to bring them together. How can we do this? You cannot sit in your citadel and imagine that you know. You have to go in there and ask them. And then we heard from Helena about when you are planning to develop a screening program, please recognize that from the moment of discovery, disparities begin. Let us not act surprised that years into our implementation, suddenly the usual suspects are being left far behind. We have to be aware, intentional, and then we have to have the policies to bring together understanding this is a problem that will emerge. And therefore, we have to be proactive in thinking through how are we going to prevent this emergence of what we know will come. And at a minimum, minimize it as much as we can. But why should we care? Why? What is the point? I mean, some of these populations are not obviously lovable, yeah? The lung cancer patient is not obviously lovable. There are no 30-year-old triathletes with lung cancer running around doing a race for the cure. The average lung cancer patient is older, has a long history of smoking, and therefore we, as a judgmental society, may regard them as much less lovable. All of lung cancer is stigmatized. We have to understand that. And what we have just heard may be some extreme examples of the populations that are stigmatized. Lung cancer is not a science problem. It is a political problem. Let me just count the ways. So the science is there. Two large randomized control trials, now several years old, a huge meta-analysis, a Cochrane analysis that clearly demonstrates that the oncologic challenge of our age has a solution to save lives. And where have we applied this solution? In some places, not everywhere else. We continue to have a lack of political will to do the work it takes to get us to where we need to be. And then, of course, we know that our work is not done. The hypothesis has been tested. There is technology that can identify people and rescue them. But our work is not done because it's only a segment of our populations. We still need to figure out a way to expand eligibility to all the people who are truly at risk. So the fact that we don't know how to do that yet doesn't mean it can't be done or it shouldn't be done. We need the political will to come together to get that done. I'm talking about those who are currently ineligible for screening. Thank you.

equity

lung cancer

disparities

political barriers

screening programs