West Virginia’s back roads — two lanes, carved into steep mountainsides — were never meant for LUCAS, a 68,000-pound tractor-trailer that brings lung cancer screening to the most rural parts of the state.
Lung cancer is the deadliest type of cancer in the United States, claiming about 125,000 lives each year — more than breast, colorectal and cervical cancers combined. Though lung cancer screening by CT scan can be lifesaving and insurers are required to cover it, the test is a little-known option. Less than 20 percent of eligible people get screened, compared with the 70 to 80 percent who get mammograms, colonoscopies and Pap smears, federal data shows.
These challenges are exacerbated in West Virginia, which has the highest smoking rate in the country and a largely rural population without easy access to a hospital with lung screening. Half of its lung cancer cases are not caught until Stage 4, when treatment options are limited.
LUCAS, which is run by the West Virginia University Cancer Institute, hit the road in 2021. It was the first fully mobile lung cancer screening unit in the country. “We have to be more creative about bringing health care to people,” said Dr. Hannah Hazard-Jenkins, the institute’s director. “As opposed to always forcing them to us.”
DURING SCREENING SEASON, which runs from March to December, LUCAS sets off on Mondays from the cancer institute in Morgantown, traverses the state and then works its way back, stopping in different counties each day. Two teams alternate weekly shifts.
Often behind the wheel is John Trembly, 45, an Air Force veteran whose family roots in West Virginia stretch back to the Revolutionary War. He maneuvers the 67-foot rig along banked highways that undulate through the mountains. Shaggy trees stand sentinel all around, with generations-old communities nestled in their midst.
When LUCAS rolled into the town of Thomas, population 600, last spring, it was hard to miss.
“It’s funny seeing semis up here, because it’s very small,” said Kurt Johnson, a 55-year-old screen printer. “There’s no place to turn around.”
Mr. Johnson had quit smoking four years earlier. An uncle had recently died of lung cancer, as had a close friend and a co-worker’s mother. His doctor had been nagging him for a year to get screened. So Mr. Johnson walked over, and although he had no appointment, the LUCAS team squeezed him in.
Inside the 18-wheeler, he found a small waiting area and a screening room surrounded by murals of the West Virginia countryside: rolling hills, lush trees and dappled sunlight.
AN ESTIMATED 3,000 mobile clinics operate across the United States, some screening for cancer, others providing immunizations, blood testing or dental care. These rolling clinics recall an earlier era in American medicine, when house calls were common, though the trappings of mobile health care have evolved considerably.
LUCAS is a $1.5 million vehicle that costs about $5,000 per day to run, according to the cancer institute. The program breaks even through insurance payments, grants and donations.
The Supreme Court recently upheld a provision of the Affordable Care Act requiring insurers to cover lung cancer screening and other preventive health services for eligible patients. Without it, LUCAS could have become unsustainable, Dr. Hazard-Jenkins said.
As of December, LUCAS had screened 4,600 people and detected 55 cases of lung cancer.
WEST VIRGINIA has a long history of outsiders sweeping in with false promises of help, only to then pillage the state’s timber, coal or other natural riches — and take off. Many West Virginians have grown leery and think, “Great, it’s here for now, but how long is it going to last?” Mr. Trembly said. “We expect it to fail from the beginning.”
Overcoming that skepticism was an early hurdle for the LUCAS team. They built trust by meeting with local providers; screening anyone who walked in, regardless of insurance status; and returning to communities again and again to see new patients and perform follow-up scans.
“There’s a profound sense of obligation to West Virginia and the people who live here,” Dr. Hazard-Jenkins said.
LAST SCREENING SEASON, LUCAS visited the town of Buckhannon a dozen times, filling a void for residents like Lester Humphreys, a 57-year-old former chef who started smoking as a teenager.
Mr. Humphreys hadn’t seriously considered getting screened for lung cancer, he said. And after selling his car to make rent, he didn’t have a way to get to the hospital, anyway.
But then LUCAS showed up.
“In America, I think that the medical field is letting people down,” he said, “but this is awesome because they’re reaching out to people.”
ON A TYPICAL DAY, LUCAS screens 25 to 30 residents. The crew also counsels people on quitting smoking and comforts those reluctant to get screened.
Barbara Jenkins, 62, nearly skipped her first appointment. If the scan found cancer, “I wouldn’t do anything anyway,” she said, adding, “We’re all going to die at some point.”
Ms. Jenkins believed that as a former smoker, she didn’t deserve care. But Mr. Trembly sat with her, talking through her concerns. Eventually, Ms. Jenkins began speaking of her son, president of Buckhannon’s annual strawberry festival, and her granddaughter. “She’s my girl. She is my absolute girl,” Ms. Jenkins said. “She’s what’s kept me going.”
Moments later, Ms. Jenkins emerged from the screening room, marveling at how quick and easy the CT scan had been. She promised to tell everyone she knew about LUCAS.
“I’ve got plenty of friends,” she said.
Simar Bajaj covers health and wellness.
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