Milwaukee VA Medical Center
Early screening helps Vet beat lung cancer
“If they hadn’t caught it, I would have been dead.”
Army Veteran John Geisthardt gave up cigarettes after he was diagnosed with emphysema, but 40 years of smoking already took its toll. His second yearly screening with a low-dose CT scan showed cancer on his left lung. After surgery, chemotherapy and follow-ups, he got the answer every patient wants to hear: “You have been declared cancer free.”
Geisthardt, who served in the Army from 1974 to 1976, quit smoking nine years before his lung cancer diagnosis. Doctors knew he was at a higher risk and would benefit from lung cancer screening. The scan, performed at the Milwaukee VA, identified the early lung cancer before it spread.
“They caught it just in time,” he said.
Geisthardt’s routine lung cancer screenings have been coordinated through a program called VA Partnership to increase Access to Lung Screening – or VA-PALS, for short.
VA-PALS was initially made possible nationwide because of a $7 million grant from Bristol Myers Squibb Foundation and a partnership with VA’s Center for Strategic Partnerships. VA’s Office of Rural Health contributed an additional $3.4 million.
The individual medical centers commit their own resources to sustain such programs. Since 2017, VA-PALS has expanded to 17 VA medical centers, and more than 19,000 Veterans have been screened.
The Milwaukee VA is one of the leading VA-PALS lung cancer screening sites in the country based on the number of patients screened in a short amount of time. Geisthardt is one of more than 1,500 in the Milwaukee area who have been enrolled in the program since 2019.
“When I can tell someone they are cancer free because we detected their cancer early on, it really feels like I am doing my job, and this is what we are trained to do,” said Dr. Andreea Anton, a pulmonologist and Medicine Division manager at the Milwaukee VA. “We are able to give more Veterans a normal life who could have potentially died from lung cancer.”
Lung cancer remains the leading cause of cancer-related deaths among male and female Veterans and across the United States. Anton said there’s less than a 20% five-year survival rate from lung cancer. But the survival from stage 1 lung cancer can be as high as 80% to 90%. With earlier detection, she hopes survival rates will continue to improve.
“This is within reach, but we need to do more,” she said.
The U.S. Preventive Services Task Force used to recommend a CT scan for those at high risk. That was defined as ages 55 to 80, active smokers or those who quit within 15 years but smoked the equivalent of one pack per day for 30 years or more.
In March 2021, the task force changed recommendations to start screenings earlier – those ages 50 to 80, who have smoked the equivalent of one pack per day for 20 years or more and currently smoke or have quit within the past 15 years.
“It’s taken time for lung cancer screenings to be implemented, but there is convincing evidence that (it) is saving lives, so it is becoming a standard practice,” Anton said.
Steven Rembalski, a nurse practitioner hired to oversee the Milwaukee program, is also optimistic survival rates will improve.
"My message to other Veterans is to do it, don't delay. Just do it, especially if you are a smoker, by all means just do it. I mean, it saved my life."Veteran John Geisthardt
“The more (screenings) we perform -- and we convince patients to stop smoking -- the more lives we can save,” he said. “There’s no reason why it can’t be better if we diagnose early cancers and follow them.”
One of Rembalski’s priorities was to make sure he reached as many Veterans as possible. He worked with primary care providers to ensure there was continuity between their practice and oncology. Instead of just one chest scan, he worked to create a timeline for regular follow-ups. He sent letters into the community.
“We want to find people before they have problems. It’s a simple, five-minute procedure that is changing lives. Quite a few times we don’t find something on the lungs, but we see other incidental findings with the livers, kidneys and thyroids,” he said.
Rembalski said he sees the future of lung cancer screening expanding to other VA hospitals and one day reaching all eligible Veterans who use VA health care.
Geisthardt said he is living proof that early detection saves lives.
“My message to other Veterans is to do it, don’t delay. Just do it, especially if you are a smoker, by all means just do it. I mean, it saved my life.”
Geisthardt said he now has time to do the things he loves, like playing guitar and enjoying the Milwaukee winters. He said it may have been a much different outcome if he didn’t have the scans.
“I am so thankful. Not only is my cancer as cured as you can cure cancer, but the expense to me has been minimal. How can anyone possibly ask for more than that?”
Dr. James Taylor is a fellow with the VA-Partnership to increase Access to Lung Screening.
(Former Milwaukee VA Public Affairs Officer Gary Kunich contributed to this story)